I’m asking here because I have a vague recollection of this being law but maybe I’m misunderstanding or misremembering. I thought this was covered under ACA or some other semi-recent law.
The situation is this: you are in the hospital and you have good insurance. It started as an ER visit. Under your insurance all you have to pay for an ER visit is a $25 co-pay and everything else is covered. Under doctor’s orders you are poked and prodded. Nothing is your idea, you are just following what the doctor is recommending. As far as you are concerned everything should be covered. Nothing is a la carte. Months later you find that one of those people bill with a different code and you are on the hook for that. No warning at the time. No real choice on your part.
I guess my question boils down to am I remembering correctly? Is this allowed?
Please, I put this in FQ for a reason. No need to tell me how glad you are that you live in x country or how you hate US healthcare.
By a different code, are you saying that the doctor was out of network, despite the hospital being in network? If so, read up on the recent No Surprises Act, which was supposed to prevent such nonsense.
I’m not sure of the difference. That may be applicable to the larger FQ question. Personally I have very good (and very expensive) health coverage. I am fully covered for all emergency room visits. I am fully covered for all hospital stays in network hospitals. I was in a network hospital. Anything that happened during the hospital stay should be covered as per the NSA mentioned above.
I remember a story where someone was having a colonoscopy and while in there the doctor removed a few polyps. The removal of those polyps was considered surgery so was billed differently that the scoping. The scoping was covered by the insurance but the surgery was not, so the patient owed the hospital money. The patient appealed with the argument they were under anesthesia and could not consent to the surgery, so the insurance and the hospital worked out what was owed and the patient ended up with the surgery covered, too.
But yeah, the No Surprises Act is supposed to eliminate most of these games. And appealing these things with the insurance company can often work - in the OP example you could argue that no one told you that an “out of network” specialist or whatever was going to work on you so you were not presented with the opportunity to decline and request someone (or some thing) that IS covered by your insurance. And given that it was in the ER you should not be expected to be asking everyone “is this covered by my insurance?”
What exactly does that mean? I was told once that I was in “observation” status - but I was given a room and so on and was never able to figure out what the difference was except that insurance might not cover observation (although mine did)